Violence In The ER

Most of us face little risk of being assaulted while we're on the job. But if you're a cop, a convenience store clerk or a cab driver, your line of work can quickly turn violent. The same is true for people working in hospitals and nursing homes. In part three of our "Danger At Work" series, KUOW's John Ryan examines violence in the emergency room.

TRANSCRIPT

From the moment you walk in the emergency room at Tacoma General Hospital, you can see security is a big concern.

Miller: "Nothing in here I need to be aware of? Guns, knives, pepper spray, any type of weapon at all? All right, go ahead and come on through here."

Security officer Marc Miller lets me enter. Everybody has to go through a metal detector to get in the ER, 24/7. It's one of many measures Pierce County's biggest hospital has taken to keep patients from attacking hospital staff.

Nationwide, health care is one of the most dangerous industries to work in, especially if you work in an ER.

Violence strikes health care workers in Washington at six times the state average. Frontline caregivers in emergency rooms and psychiatric wards get assaulted even more than that.

At Tacoma General, most anti–violence measures are more subtle than a metal detector. Much of the staff is trained how to pacify agitated people. Even the colors and spaces of the ER's new waiting area were designed to soothe injured, stressed out, impatient patients.

But sometimes all the soothing design and verbal de–escalation techniques in the world won't keep a patient from acting out — that's what health care people call it when someone gets violent. So some of the exam rooms are extra secure.

Sound: (Gate clangs)

A metal gate comes down to protect expensive and potentially dangerous medical equipment from any out–of–control patients.

Gary Barth is in charge of security at Tacoma General and its sister hospitals.

Barth: "On other side of the metal wall, there's stuff that could be torn off the wall and used as a weapon to hit staff. If they start acting up, they'll start tearing all this stuff out."

Even the card reader that unlocks the door from the inside is invisible. It's hidden inside the wall.

Barth: "Just one less thing to get destroyed if they're acting out."

The most violent profession in Washington isn't a cop or security guard or corrections officer. It's a nurse's aide, and registered nurses are next in line.

Rinehart: "Everything from being spit at to being pushed, shoved, knocked down, hit with fists, kicked — I see it all the time."

Jeaux Rinehart is a Seattle nurse and president of the state's Emergency Nurses Association. He agreed to be interviewed only if I did not name the hospital he works at.

Rinehart: "There are times when you can see it coming, there are times when it comes out of nowhere."

Rinehart is a big man. Even so, he's been billy clubbed in the head by a mentally ill patient seeking narcotics. Most recently, an intoxicated patient punched Rinehart in the face and spat on him. Rinehart and his co–workers then restrained the patient and moved him —

Rinehart: " — To an area where the security guards could actually sit and watch him. He said very loudly to me, 'When I get out of here, I'm going to go get a gun and come back and kill you.' Luckily, there was an on–duty Seattle policeman in the department who heard this."

That patient spent three months in jail. Assaulting a health care worker is a felony in Washington. But typically, much less is done when a nurse is assaulted.

Rinehart: "A lot of hospitals don't really encourage nurses to report violent acts against them, and some facilities just feel that it's part of your job, and you should just simply tolerate it, knowing that if you work in an emergency department, violence is going to be there, so prepare for it."

Ryan: "But given the reality of intoxicated patients — maybe mentally ill patients, coming into a very stressful situation where they may be in pain — is there a way to have it not be part of the job?"

Rinehart: "You wouldn't tolerate it on the bus. You wouldn't tolerate it at home. You wouldn't tolerate it in the grocery store. Why should I tolerate it at work?"

Nurses' unions want hospitals to do more to protect their workers, like more hands–on training on how to avoid or defuse violent situations. Sharon Ness is a nurse with the United Food and Commercial Workers union.

Ness: "Everybody needs to be trained. Not just security guards, not just the big men that are working on the floor, but every nurse's aide, every housekeeper, everybody needs to be trained on how to work in the situation."

It might not be surprising that labor unions also push higher staffing levels as an anti–violence strategy. But researchers agree that under–staffing can make hospitals more violent.

Nan Yragui studies workplace violence. She's a psychologist with the Department of Labor and Industries.

Yragui: "When nurses are overworked, overloaded, they can't give the time and attention to a patient that that patient might need. And patients get frustrated having to wait when they're stressed and anxious about their own health."

Yragui says budget cuts to the health–care safety net have also made emergency rooms nationwide more violence–prone.

Yragui: "When patients can't get services they need, they end up going to the emergency department. So more of the severely mentally ill are going to the emergency department and then that makes that group of nurses more at risk because they're getting more exposure."

Those factors helped fuel a rise in violence last year at Providence St. Peter Hospital in Olympia.

Jeff Glass: "When we looked at the data for 2010, we saw a 26 percent increase in the number of what we call code gray incidents."

Jeff Glass is the hospital's director of facilities. He says the types of patients showing up from the five counties it serves in southwest Washington changed.

Glass: "Probably drug/alcohol and mental illness are the two drivers."

But how to keep the peace in a hospital isn't always straightforward.

Two years ago, a patient smuggled three guns into the Providence St. Peter ER. Before the night was over, he wound up dead — shot in his treatment room by an Olympia police officer.

St. Peter officials made a raft of changes after that: more training for caregivers, better security systems. Still, they opted not to install a metal detector. Here's Jeff Glass:

Glass: "That will slow down the flow of patients into the emergency center, and that delay in care was a higher risk than the probability of being able to find a weapon on a patient."

Instead, they wave a hand–held metal detector at patients they deem high risk.

The guards at Harborview Hospital in Seattle run a metal detector on the overnight shift. Harborview has clashed with its security guards and state regulators over workplace safety.

The Department of Labor and Industries has cited Harborview 11 times in the past three years for serious violations. In November, the state fined Harborview $13,000 for failing to provide a safe workplace for its security guards.

Nervik: "Every time we do get involved in helping someone, we're concerned about losing our jobs — and getting hurt."

I met with Mike Nervik in the morning after he'd gotten off his graveyard shift at Harborview. He's been a security guard there for more than a decade. He's also a shop steward for the Washington Federation of State Employees.

Nervik: "We don't want a risk–free environment, but we want to be supported. We want to get the stuff we need to do the job the best we can."

That stuff includes the batons that management took away from the guards last year and consistent policies and training on how to handle violence and weapons.

Nervik: "We get the same training as the rest of the staff. But the problem is the training says, when you run into trouble, call for help. But we are the help."

Harborview's security manager told a state inspector that the security officers should resemble a concierge service, not a police force.

Public records show someone being assaulted at Harborview about every couple days last year. On a recent Saturday night, a patient managed to walk into the emergency room with a collection of weapons in his backpack. They included a large knife, two cans of pepper spray, a cap gun and lots of bullets.

Harborview management wouldn't answer questions or allow any interviews about violence there. Spokesperson Susan Gregg did email a brief statement to KUOW. It says Harborview uses best practices from the health care industry to achieve its goal of providing a safe environment for everyone.

Harborview has appealed the fines, calling them arbitrary and capricious enforcement of the state's workplace safety rules.

Graveyard–shift guard Mike Nervik says despite the hospital's shortcomings, Harborview is a lot less violent than it was in the 1990s.

Nervik: "Like 15 years ago, you'd go home just wringed out in sweat, having gotten in confrontations with several people."

Statewide, health care workers have been reporting fewer violent injuries than they did in the 1990s. But with many workplace assaults going unreported, it's hard to say whether the programs and laws aimed at making hospitals safer have actually done so.